Former HealthSouth executives join Nexus

Nexus Health Systems has added two new executives in key positions that had been vacant for more than 18 months.

Edward A. Downs has been named chief operating officer, while Rob Tyler has been brought on as chief financial officer of Houston-based Nexus. Both executives previously worked for Birmingham, Ala.-based HealthSouth Corp.

Nexus was founded in 1992 to create a specialized health care environment in which patients with catastrophic neurological injuries could receive treatment and rehabilitation specific to their needs.

The company currently operates four medical specialty hospitals and a residential rehabilitation campus.

Whether working as the director of a brain injury program at a Houston hospital or as a neuropsychology expert hired by law firms to determine long-term medical needs of accident victims, Charlene Madison-Cassidy saw first-hand how traumatic injuries could turn a person's life upside down.

She also saw a business opportunity.

"The questions kept coming up from patients who were not so focused on their needs right now but wanting to know what would happen five or 10 years down the road because they knew the disabilities weren't going to go away," says Madison-Cassidy. "Someone with brain and spinal cord injuries has to deal with that the rest of their life, and the families have to deal with it financially."

As a result, Madison-Cassidy founded LifeCare Planning Inc. in 1989 to help people with catastrophic injuries, long-term disabilities or chronic illnesses -- and their families -- coordinate the health care and funding issues involved.

While the concept may have been ahead of its time when LifeCare was created, the firm is now in the midst of a major growth spurt. That effort includes adding staff and expanding office space while being courted by national insurance companies which, as Madison-Cassidy once did, sense that life care planning is a hot commodity.

Madison-Cassidy points out that life care planning simply didn't exist 25 years ago, a time when life expectancies were shorter.

In the 1980s, the funding issues related to long-term care weren't as important as they are today, she says, so LifeCare was developed in 1989 more from the litigation side.

"But what has evolved over the years is this new discipline that's much more precise and thorough," Madison-Cassidy says.

The building block on which LifeCare is based is its "Physician-Led Team Specific Care Planning Method." Rather than using an administrator or a rehab nurse to coordinate a patient's long-term needs, LifeCare puts a medical doctor at the head of the team.

"The physician is in the best position to bridge that gulf and look at each case from a clinical perspective and not only project what will be needed to care for someone 10 years from now, but monitor those needs annually," Madison-Cassidy says. "As the needs change, the costs can go up or down."

LifeCare has three physicians on staff -- and seeks to hire two more this year -- who coordinate care in each case with occupational, physical and speech therapists, social workers, nurses, financial planners, educational and vocational trainers and other professionals.

Madison-Cassidy says it is unrealistic for one worker to address all these needs, so LifeCare uses the traditional rehab team approach, but with a doctor as team leader.

John Cassidy, who is also president and CEO of Nexus Health Systems, is LifeCare's medical director, and Madison-Cassidy's husband. Relying on his more than 25 years' experience in brain injury cases, Cassidy acts as a coach and consults with the LifeCare physician team leaders.

Nexus Health provides medical and rehabilitative care following acute injury or illness.

Cassidy suggests the LifeCare model has been successful because it coordinates medical and financial needs simultaneously, while remaining cost-effective.

"When people plan to fund a child through college, they set money aside but have no perspective on realistic costs when the time actually comes," he says. "Families are terrified they might have to commit their entire savings to long-term care, but we help them figure out how to spread those resources around."

Soon after setting up LifeCare, Madison-Cassidy realized she may have been spreading her own resources too thin. She also realized that she had some serious decisions to make.

"Most health-care provider types have an abysmal lack of training when it comes to management," Madison-Cassidy says. "I realized that if I was going to accomplish my goals, I would have to treat it as a business and get the help and expertise I needed instead of trying to do everything myself."

In the mid-1990s, Madison-Cassidy made the pivotal decision to leave the clinical work she had enjoyed for years, and to merge her private neuropsychology practice into LifeCare.

"I knew I couldn't do everything effectively, but it was very difficult to give up my identity as a hands-on care provider," she says.

The business of care

LifeCare moved several times during the 1990s, as Madison-Cassidy slowly began to add staff. Still, it was not until after 2001 that the business, which now employs 12 people, began to grow substantially.

Madison-Cassidy said her most rewarding decision to date was hiring Andrew Pikoff in March 2003. Pikoff, a Houston litigation attorney at the time, had used LifeCare to help determine life care planning costs for some of his clients. One day over lunch, Madison-Cassidy suggested he should look into a new career to take advantage of his business acumen. He called her back and said he found his niche, and it was at her company.